By Elizabeth DickinsonElizabeth Dickinson is a Gulf-based American journalist and former assistant managing editor at Foreign Policy.

September 8, 2010 - 4:25 pm

The New York office director of UNAIDS, Bertil Lindblad, is worried about the one region of the world where HIV infections are increasing, even as rates in the rest of the world level off. It’s not in Africa or Asia, or even Latin America. It’s Eastern Europe — countries like Russia and Ukraine — where a recent UNICEF report notes that increases in infection rates of as high as 700 percent have been seen since 2006.

"There is an urgent need for the whole Eastern European and Central Asian region to act quickly," Lindblad said this morning. "This is really quite scary given the fact that there is denial, and so much stigma and homophobia [in that region.] This could really create huge problems if HIV continues to spread from smaller groups in the population to wider."

It’s HIV/AIDS’s silent crisis, one that has been underway for the last decade. The region is home to a quarter of all injection drug users in the world (3.7 million), and this is where the epidemic is believed to have begun. These users are young — most of them teenagers. But from there, HIV spread to sex workers (the majority of whom are also under 30), and now has fully moved into the everday lives of men and women in the region, married and unmarried. A mark of the epidemics progression — from specific populations into the majority — is the new incidence of HIV among women, who account for 40 percent of all new infections (that’s up from only 24 percent at the turn of the century.)

The stigma attached to the disease — and more importantly, to the groups of people percieved to be the majority infected with it — is the biggest obstacle to doing anything about the disease. "Those living with HIV have been silenced and excluded, and risky behaviours borne of futility and hopelessness have been sanctioned or repressed," the UNICEF report notes. Government officials are said to be resistant to admitting the scale of the problem, and today that country remains a difficult places for AIDS advocacy, says Lindblad, who formerly worked in the UNAIDS office in Moscow.

But where there is challenge such as this, there is also often opportunity. Russia, I would think, should have a very serious interest in addressing this crisis. For starters, because AIDS threatens to exacerbate its larger demographic problem — that of a fast-shrinking population. But the other point might be even more convincing: The injection drug users are using heroin. And that heroin comes from Afghan poppies. For Russia, tackling the illegal drug market in Afghanistan — one which fuels the insurgency — is a serious national security issue.

Of course, good old fashioned peer pressure might help edge them along as well. And when the U.N. General Assembly meets later this month, one of the side conversations, according to Lindblad, will be a discussion on HIV/AIDS "co-hosted by the government of China, the government of Nigeria, and UNAIDS," specifically, the Chinese premier and the Nigerian president (South Africa’s President Jacob Zuma was also supposed to come, but had to cancel.) "That could influence other big countries such as Russia, for example, to turn around."

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Daniel W. Drezner is professor of international politics at the Fletcher School of Law and Diplomacy at Tufts University and a senior editor at The National Interest. Prior to Fletcher, he taught at the University of Chicago and the University of Colorado at Boulder. Drezner has received fellowships from the German Marshall Fund of the United States, the Council on Foreign Relations, and Harvard University. He has previously held positions with Civic Education Project, the RAND Corporation, and the Treasury Department.

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Joshua Keating is associate editor at Foreign Policy and the editor of the Passport blog. He has worked as a researcher, editorial assistant, and deputy Web editor since joining the FP staff in 2007. In addition to being featured in Foreign Policy, his writing has been published by the Washington Post, Newsweek International, Radio Prague, the Center for Defense Information, and Romania's Adevarul newspaper. He has appeared as a commentator on CNN International, C-Span, ABC News, Al Jazeera, NPR, BBC radio, and others. A native of Brooklyn, New York, he studied comparative politics at Oberlin College.

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Laura M. KelleyLaura M. Kelley is the principal author of the U.S. National Intelligence Council's 2002 study, The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India, and China. Nicholas Eberstadt is the Henry Wendt chair in political economy at
the American Enterprise Institute, senior advisor to the National
Bureau for Asian Research, and is working on a book on the global
impact of the AIDS pandemic.
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